Revisiting methylprednisolone aceponate: efficacy, safety and current positioning.

BACKGROUND: Topical corticosteroids are essential for the management of inflammatory skin diseases but optimizing efficacy whilst minimizing adverse effects remains critical. Methylprednisolone aceponate (MPA) is a fourth-generation, non-halogenated corticosteroid developed to enhance local activity with limited systemic exposure. This review summarizes its pharmacology, clinical efficacy and safety. METHODS: A PubMed search (1990-2025) was conducted to identify relevant studies on MPA in inflammatory dermatoses. RESULTS: MPA's di-esterified structure and 6α-methyl modification provide potent anti-inflammatory activity with low atrophogenic potential. It is activated within the skin to a highly active metabolite and rapidly inactivated systemically, resulting in minimal systemic absorption. Clinically, MPA provides rapid pruritus relief and high clearance rates in eczematous conditions, including atopic, contact and seborrheic dermatitis. Once-daily application is generally sufficient, supporting adherence. Its availability in multiple formulations allows treatment to be tailored to lesion type and anatomical site. Long-term use is associated with a low risk of skin atrophy or hypothalamic-pituitary-adrenal axis suppression, and allergic sensitization is rare. CONCLUSIONS: MPA offers an effective and well-tolerated option for acute and maintenance management of inflammatory skin diseases.